I dozed off for about ten seconds during a session today. Over the last 30 years, this has happened to me three times that I recall. The first time was with an elderly client, benignly psychotic but disengaged from the therapeutic process; briefly dozing made me realize I’d come to feel that I couldn’t help her. The second time, I had just returned from abroad and went back to work too soon; I was jet-lagged and nodded off during what would have been night in my former time zone. Today, it happened with a client of long-standing. I’d finished another session immediately before this one and did not feel tired. It was mid-day and I’d slept reasonably well the night before. Just prior to my eyes closing, my client had told me she was feeling so tired she just wanted to drop off, fall to the ground and go to sleep.
I’ve experienced this kind of sleepiness before, with several different clients — a sudden, out-of-the-blue feeling that my eyelids are so heavy I can’t keep them open. (I’ve also felt tired on many other occasions — my own fatigue, from stress or too little sleep the night before — but not dozed off.) Usually I’m able to tell the difference between them, whether it’s my own exhaustion or a … well, a kind of communication. On the woo-woo scale of things, I’m fairly skeptical, but I do believe in something like ESP — a capacity to perceive through a sensory apparatus other than one of the five usual suspects. I believe good therapists are highly sensitive in this area. In broad terms, you might think of it as a kind of countertransference response or a form of empathy.
The usual metaphor used to describe empathy is “putting yourself in someone else’s shoes,” which implies that the person who empathizes actively does something to identify with the other person, going outside of him- or herself into the other. I prefer to think in terms of a sponge, where the empathizer absorbs a portion of the other person’s emotional experience — say, his suffering. At the same time, the person suffering may project her pain as an unconscious kind of communication. I find that I often “tune in” to the very feelings my clients need (but can’t seem) to feel.
I worked for a number of years with a young man in his twenties whose father had been very strict and authoritarian. Tim was detached from his feelings most of the time and I found it hard to make emotional contact with him. During many sessions, as I was sitting in my chair behind the couch upon which he silently lay — in other words, where I couldn’t see his face or read his expressions — I would feel a wave of sadness come over me. Tim had said nothing for several minutes beforehand. I’d feel an ache in my chest and at the back of my throat; my eyes would well up with tears. Experience had taught me that asking him “What are you feeling?” would get us nowhere. Instead, I’d ask him to direct his attention to those same places — his eyes, his chest, his throat — and describe his sensations. Most times, this helped him connect with his sadness, though it remained very difficult to understand the meaning of it.
With another client, I used to feel my face going numb, as if my head were being subjected to enormous pressure. This led us to some pretty interesting fantasies about her birth. On occasion, I’ve felt physically aroused and puzzled, just before an embarrassed client finally admitted to a sexual fantasy about me. We therapists don’t usually talk about these things, either because they make us appear wacky or because it sounds unprofessional when a therapist admits to having sexual feelings during session. Just for the record, I have never felt even slightly tempted to act on those feelings. I’ve always understood them as some kind of unconscious communication.
In session today, my client immediately understood that my sleepiness had something to do with her own experience. I told her that I hadn’t been feeling tired before session, but that I’d been fighting to keep my eyes open for several minutes before they actually closed. As soon as we began to discuss the “soporific” way she’d been talking beforehand, we both felt much more alert, suddenly wide awake. I doubt we completely understood what happened, but we were able to link our sleepiness to her fear of having distinct opinions and voicing them (as seen in material from earlier in the session), along with the anxiety she felt about being perceived by others as competent, even an authority. Coming into her own — waking up to herself, as it were — feels dangerous for all sorts of reasons; she’d prefer to fall back asleep.
During sessions with clients over the years, I’ve felt many different ways — angry, resentful even envious — but I could usually link it to the verbal material — words actually said or expressive tones of voice. The more fascinating experience, much harder to explain, is the one that emerges from silence, without words or visual cues to account for it. As a therapist, you have to be a bit skeptical; you can’t assume that everything you feel in this way is a kind of projection from your client. But if you exercise caution, this mysterious kind of empathy can prove a useful addition to your clinical toolkit.